June 26, 2025

Dear CNO

A female nurse speaking into an AI app on a smartphone while looking at patient’s chart.

I am a nurse providing virtual care to a new patient who speaks English as a second language. I used an artificial intelligence (AI) translation app to obtain informed consent, but I’m unsure if the patient fully understands the proposed procedure we discussed. What are my accountabilities in this situation? 

This is such an important question, and I’m glad you’re giving thoughtful consideration to the process of obtaining informed consent, which depends on the patient’s understanding of the information provided. When working with patients who may face language barriers and given that virtual care can impact communication, it’s essential to ensure the information being shared is fully understood. Using AI translation tools can be helpful, but they’re not always perfect, and you’re right to be cautious.

For example, AI tools or apps may assist in supporting a patient’s understanding when language or cultural barriers exist, but they may not be sufficient as their response can sometimes be inaccurate or reflect cultural biases. It’s your accountability to assess whether these tools are appropriate, accurate and aligned with evidence-based practice, as well as employer policies. 

Start by confirming the patient’s understanding of the procedure and if they are truly giving informed consent. In addition to confirming the patient’s understanding of the information, consider their comfort with the technology. If there’s any uncertainty, you should arrange for an in-person follow up with a certified translation service or a bilingual member of the health care team. 

For more guidance, check out CNO’s new Virtual Care guideline and Artificial intelligence in nursing practice page, which outline certain considerations for nurses when providing care to culturally diverse patients and obtaining informed consent. Remember, it’s important to always put patients’ needs first. If virtual care doesn’t seem to be the most appropriate option when providing care and obtaining informed consent, you should explore other options.

As virtual care is becoming a more common way for people to access health care services, communicating effectively through this medium is crucial to forming a therapeutic nurse-patient relationship and ensuring patients receive safe, quality care. 

Thanks for writing in. 

Sarah Alley, RN, BScN, MPH
Advanced Practice Consultant, Practice Quality 

About CNO

The College of Nurses of Ontario (CNO) is the regulator of the nursing profession in Ontario. It is not a school or a nursing association. CNO acts in the public interest by:

  • assessing qualifications and registering individuals who want to practice nursing in Ontario.
  • setting the practice standards of the profession that nurses in Ontario are expected to meet.
  • promoting nurses' continuing competence through a quality assurance program.
  • holding nurses accountable to those standards by addressing complaints or reports about nursing care.

The College was founded in 1963. By establishing the College, the Ontario government was acknowledging that the nursing profession had the ability to govern itself and put the public's well-being ahead of professional interests.

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Anyone who wants to use a nursing-related title — Registered Nurse (RN), Registered Practical Nurse (RPN) or Nurse Practitioner (NP) must become a member of CNO.

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All public information available about nurses is posted in the public Register, Find a Nurse, which contains profiles of every nurse in Ontario. Publicly available information about nurses include their registration history, business address, and information related to pending disciplinary hearings or past findings.

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